Holly Drone: Advancing clinical pharmacy in the opioid crisis

Dr. Holly Drone and Dr. Tim Kummer, assistant medical director at Hennepin EMS and co-lead of the MN Bridge team.

PharmD alumna Dr. Holly Drone is tackling the opioid crisis systemically. As a clinical pharmacist in emergency medicine and in Hennepin Emergency Medical Services (EMS), she co-leads a team of six paramedics specially trained in caring for patients who have overdosed or live with opioid use disorder. Drone said the team was “born from a need in the community to bridge patients from emergency care to community care.” 

This EMS model has been up and running since this past spring and is currently funded through the federal Overdose Data to Action grant intended to increase low-barrier access to medications for opioid use disorder. Several hospitals are working on something similar, but the emergency department at Hennepin Healthcare already treats a large proportion of patients with opioid use disorder in Minnesota, so the team is shifting focus to the “prehospital space,” meaning what happens before a patient is transported to the hospital. A major part of that looks like supplying 911 trucks with suboxone (a combination of buprenorphine and naloxone) to administer immediately post-overdose before the outreach team works on supporting patients through the following weeks. Drone said the team follows up on referrals from the clinic, emergency department, jail system, and community partners to assess and meet patients’ needs. 

“They're able to meet patients where they're at— whether it's a homeless encampment, the library, their apartment, their mom's house— and actually treat them in their space,” Drone said. “If it happens to get people started on the pathway to treatment, then that's amazing… We're taking the next step— what does day two look like for people? Or next week? Do they need social support? Do they have food on the table? Sometimes it's a lot later that people are ready to connect with other services or think about the next step in their journey.” 

The outreach group is partially inspired by a similar community paramedicine program in Austin, Texas, Drone said, and also noted that Seattle, Washington has an advanced mobile team that accompanies every overdose 911 call in the city. Drone’s team is one of the first to attempt what she calls “the two-pronged approach” of supplying emergency vehicles with suboxone first and conducting followup services later— most teams do the reverse or only one of the two. 

“We're hoping we can prove that this is a worthwhile and feasible model for emergency medical services in various areas— I think it has a huge role in the rural areas, where access to clinics is much harder than in the Twin Cities,” Drone said. “By law, paramedics can carry and administer medications, which fills an important gap in the continuum of care that others cannot. We’re working alongside harm reduction teams and community health workers to build a more seamless system that meets people where they are, can treat them for symptoms in the moment or get them started on medication, and connects them to ongoing support.”

Drone was drawn to EMS in particular because “they’re a very nimble group” with only a specific set of medications on hand, which they use in particular ways and in the hardest of places, she said. She described operations, purchasing groups, pharmacists, paramedics, and their medical directors as working in “different worlds,” which often breeds miscommunication.

“[Paramedics] are in someone's living room wedged between a bed and a wall doing a cardiac arrest, [for example], and that's something that’s really hard to understand when you're not working in that space,” Drone said. “I was able to start speaking the language between the two groups, which was super key. Everyone wanted to help each other, but they weren't speaking the same language.”

So far, Drone’s EMS team has mostly treated patients who have already interacted with the Hennepin Healthcare system in some capacity, though they’re beginning to receive referrals from community partners for patients who haven’t. They’re also piloting a partnership with YourPath, a telehealth platform for those recovering from substance use issues, to see if more patients connect to the resource when referred by paramedics. Most recently, Drone and her team launched MN Bridge, a web resource for EMS agencies on more effective methods of engaging with the opioid crisis— stocking their ambulances with naloxone kits, educating paramedics on stigma, creating a training program for using buprenorphine in 911 services, etc.— that compiles research, articles, template protocols, and training materials into one platform. On top of that, the team is presenting data from their emergency responses at discussion groups around the state to help spread awareness about this approach.

“This isn't something that you necessarily learn in school— how to do these things that are a little bit bigger than direct patient care,” Drone said. “It's been a really rewarding and unique opportunity to spend time doing both patient care and being able to hopefully start affecting things on a system level, because these big systemic problems can feel so overwhelming when you're just doing your day-to-day work.”